Sigmoid colon resection is performed for injuries and tumors that damage the large intestine. In most cases, such surgery is carried out urgently. There are several ways to perform this operation. Most often it is done by the method of Mikulich or Hartmann. Of great importance is the preparation for surgery. Only under all conditions can negative consequences be eliminated.
general information
What is a sigmoid colon resection operation? By this term is meant an incision of a part of an organ. For certain pathologies, part of the sigmoid colon must be removed.
The choice of removal method depends on the type of pathology. For example, a laparoscopic resection of the sigmoid colon is performed using a specialized medical technique called a laparoscope. The surgeon makes several incisions in the navel to insert the instruments. Laparoscopic technique is considered less traumatic and more sparing than open surgery.
What is the sigmoid colon?
On average, the intestinal length in the human body is 4 meters. The sigmoid colon occupies approximately 1/8 of the part. This part of the intestine is located on the border between the peritoneal cavity and the small pelvis - in the left iliac fossa. Outer iliac vessels, the left piriformis muscle and the left sacral plexus are located behind the sigmoid colon. In front - the bladder in men and the uterus in women, as well as loops of the small intestine. Due to the proximity of the intestine to these organs, the operation is considered to be difficult from a technical point of view. Due to its location, the sigmoid colon is easily palpated.
Diagnostics
What is it and what is its feature? A doctor can determine several parameters at once: organ thickness, approximate texture, peristalsis intensity and surface texture. In the normal state, this section of the intestine is quite dense, does not growl, its thickness reaches 2.5 cm. Moreover, it can be quite mobile. If a palpation reveals a lump or swelling, other diagnostic methods may be used. The patient is prescribed a blood test, radiography, sigmoidoscopy and irritoscopy. Women are additionally referred for examination by a gynecologist, since many female diseases are similar in signs to sigmoid colon pathologies.
Indications
When is a sigmoid colon resection performed? The operation is prescribed for developing tumors, progressive polyposis, the presence of large benign formations, which subsequently can lead to complications. Also, an indication for this operation is a violation of innervation, causing an increase in intestinal volume, and ulcerative damage to the mucous membranes. An urgent need for surgery may occur in case of trauma to the abdomen and internal organs.
Preparatory stage
Let's dwell on this in more detail. Before the operation, the patient must undergo some preparation. To exclude the possibility of infectious infection during the intervention, it is necessary to cleanse the intestines. This will avoid further complications. For cleansing, special enemas with a laxative are placed. Drugs and their dosage are selected individually by the doctor. The preparatory phase usually lasts all day.
Special nutrition is prescribed a few days before surgery for resection of the sigmoid colon. Diet usually excludes the use of heavily digested and solid foods. You can eat milk porridges, soups and other liquid dishes.
Before the operation, special medications are usually prescribed. These are inhibitors, diuretics and drugs to normalize blood pressure. These drugs reduce the risk of heart complications. A few weeks before the operation, it is recommended to stop taking medications that have an anti-inflammatory effect - Ibuprofen, Nurofen, Aspirin. They change the functioning of platelets and affect blood coagulation. It is also better to consult with your doctor about taking dietary supplements and vitamins. Before resection of the sigmoid colon, their intake is better to stop.
Before surgery, the patient should be examined by an anesthetist. He evaluates the condition of the patient and assigns him an appropriate anesthesia. When preparing the intestines for resection, it is not recommended to take any food, and before the operation - drink water.
Methodology
How is sigmoid colon resection performed? The course of the operation depends on the type of pathology. With an inversion of the intestine, which provoked the development of gangrene, Hartmann or Mikulich surgery is usually prescribed.
What is its feature? Hartmann resection of the sigmoid colon involves the removal of a dead section of sigma, stitching of the distal end and the subsequent withdrawal of the passage opening. This method is usually used for elderly and debilitated patients.
Resection of the sigmoid colon according to Mikulich is carried out in two stages. First, part of the sigmoid colon is removed. Its ends are stitched over 5 cm. After that, they are sewn in the form of a double-barreled shotgun into the peritoneal wall. After 3.5 months, the intestinal fistula is closed.
The method of the operation is determined by the nature of the development of pathology. If a tumor is located in the middle third of sigma, complete removal of the sigmoid colon may be required.
Postoperative period
What is its feature? What should be the nutrition after resection of the sigmoid colon? Semi-prepared foods, fried and fatty dishes are contraindicated for patients. It is better to cook food steamed or in a slow cooker.
Diet after resection of the sigmoid colon involves eating mostly liquid foods: cereals, light soups and mashed potatoes. Gradually, solid food can be introduced into the diet. The menus are designed so that the body receives all the vitamins and minerals necessary to restore the patient. After resection, canned food, smoked dishes and alcohol should be excluded. About 10 days after surgery, you can start consuming low-fat dairy products, eggs and meat. After a month, you can include ordinary dishes on the menu. The main condition is that the food should be well chopped.
Contraindications
Who should not have surgery such as a sigmoid colon resection? Contraindications are factors that cause complications in the process of removing a section of the sigmoid colon, as well as complicating the identification of nearby organs and blood vessels. Larger tumors and severe obesity also belong to inadmissions. Recent surgery and adhesions also make surgery impossible.
Consequences and forecast
This aspect should be given special attention. What complications are possible after surgery? Resection of the sigmoid colon is an intervention that is characterized by high rice causing internal bleeding as a result of poor vessel handling. The cause of the negative consequences can also be improper preoperative preparation, poor bowel cleansing and impaired tightness of the joints during healing of the stumps. Unprofessional drainage of the peritoneum can also entail certain difficulties. Sometimes after surgery, intestinal adhesions appear, which leads to obstruction.
Does resection of the sigmoid colon help? Doctors usually give a favorable prognosis. The probability of a fatal outcome tends to zero. With oncology, relapse usually does not occur. The main condition for a successful operation is the high professionalism of the surgeon and the attending physician.
Features of operations
There is a relationship between the condition of the intestine and most diseases. Failures in the work of its departments can lead to such unpleasant consequences as pain, bloating and even shortness of breath. Surgical methods of treatment are used only if other methods do not bring positive results. When carrying out a number of operations, such as excision of the fistula, partial removal of the colon and treatment of purulent peritonitis, the likelihood of contamination of the surgical area is increased. This can cause infection of the intestinal region and subsequently manifest as inflammation.
Resection of any part of the intestine is a last resort. It is prescribed in the event of a cancer of the colon or sigmoid colon. In this case, the damaged part of the intestine is removed, and the free ends are stitched together. If there are contraindications for such an operation, a colostomy is used. With this type of surgical intervention, a fistula is used, which is displayed outside. A kalopriemnik for artificial defecation joins it. Some time later, this defect can be eliminated by repeated surgery to restore the intestines.
Fistula after surgery
So what do you need to know about this? Fistula treatment can be performed both conservatively and surgically. The first option involves the use of special antiseptic washes, as well as taking antibiotics. Typically, such procedures do not give the desired effect.
Surgery is more effective. Usually, the operation includes opening the inflamed area and draining the cavities with accumulations of pus. Tissues around the excised fistula are restored in about a week. The first time after surgery, minor bleeding is possible. Relapses are quite rare, and are treated with repeated surgical intervention. Recovery in most cases occurs quite quickly.
Late rehabilitation period
Since the main purpose of the sigmoid colon is the absorption of moisture from the feces, then when this part of the intestine is removed, feces can become liquid and almost uncontrollable. This can be a nuisance. After the operation, you will have to radically revise the diet. The late period of rehabilitation requires certain restrictions. Typically, the patient is prescribed a diet with a minimum content of toxins. The menu should not be anything sharp, greasy, smoked and spicy. Doctors do not recommend eating legumes, coarse foods from plant fibers, sodas, and whole milk. This will reduce gas generation.
Conclusion
In this review, we examined in detail what the resection of the sigmoid gland is, in what cases it is performed and what may be the complications after this operation. The procedure can be carried out both planned and urgently in case of injury. There are several methods for performing this type of surgery. The specificity of the operation is determined by the doctor based on the characteristics of the patient's body. With proper preparation for surgery, complications practically do not arise. After the intervention, possible consequences such as intra-abdominal bleeding, peritonitis (with poor-quality sanitation of the abdominal cavity or incomplete tightness of the joints), as well as abscesses and early adhesive obstruction. During rehabilitation, it is recommended to reduce the burden on the body and change the diet. The diet after resection of this intestinal section excludes the use of spicy, fried, smoked, salty dishes, as well as alcohol.
Despite the fact that complications after surgery can be avoided, it is better not to bring things to surgery. Do not spare yourself the time, at the first symptoms of the disease immediately consult a doctor.